Application for LHC’s Leadership Premier 2027 Program

Ready to join Leadership Premier next class and be a part of our community of leaders? Complete the form below. For more information, visit our FAQ page or register online for one of the upcoming Informational Sessions, both virtual and in-person sessions are available. Please direct any questions to Tim Payne, LHC President & CEO.

Leadership Premier 2027 Application

Personal Information
Name*
First Last
Preferred Name
Preferred Pronouns
Birthdate*
Gender*
Ethnicity*
Year Arrived/Employed in Howard County
What year did you first arrive in, or were you first employed in Howard County?
Please enter a number from 1900 to 2024.
Home Address*
Street Address City State ZIP Code
Personal Email*
Home Phone
Mobile Phone*
Employer Information
Employer*
Date of Hire (month/year)*
Type of Business
Business Phone*
Title
Work Email*
Preferred Email*
Please note which email you prefer LHC send communications to.
Responsibilities
Business Address*
Street Address City State ZIP Code
Business County*
Work History
Additional Employer 1
Title/Responsibility 1
Start Date 1 (month/year)
End Date 1 (month/year)
Additional Employer 2
Title / Responsibility 2
Start Date 2 (month/year)
End Date 2 (month / year)
Additional Employer 3
Title/Responsibility 3
Start Date 3 (month/year)
End Date 3 (month/year)
Education
Name /City of Institution(s)
Degree(s)
Special Honors & Awards
Community Involvement
Member Organizations*
Please list up to three civic, professional, business, religious, social, community, athletic, or other organizations of which you are or have been a member. State the name of the organization, the dates of membership, and your responsibilities.
Leadership Roles*
Please list your current volunteer leadership role(s). State the name of the organizations, your position, and describe your responsibilities for each.
Important Accomplishments*
What do you consider to be your most important accomplishment in one of your volunteer roles?
Special Honors*
What special professional or civic honors or awards have you received? Please indicate dates.
Involvement Conditions
If you have a limited history of volunteer involvement, how do you expect that to change so that you will be able to give back more after completing the LHC Premier program?
Volunteer Time*
How much time each month do you commit to volunteer service?
Challenges Facing Howard County*
In 50 words (or less), please briefly explain what you believe are the three (3) most significant challenges facing Howard County.
Effecting Change*
Please select one of the challenges you've indicated above and describe in 50-100 words what measures you feel need to be taken to effect change for the better.
County Opportunities*
From your perspective, what are the three (3) most notable strengths of Howards County? Please use 50 words (or less) for each strength.
What specific skills or knowledge do you hope to gain from your participation in Leadership Howard County?*
What unique perspective or experience do you feel you can contribute to this Leadership class?*
If you had one week to devote to a community service project, what would you do and why?*
References
Two (2) references are required per candidate. It is THE CANDIDATE'S responsibility to reach out to your selected references and send them the link below to complete; the form link may also be found on the LHC website. Please note that LHC will NOT send these directly. https://www.leadershiphc.org/programs/leadership-premier/
First Name (Reference 1)*
Last Name (Reference 1)*
Email (Reference 1)*
First Name (Reference2)*
Last Name (Reference 2)*
Email (Reference 2)*
How did you learn about Leadership Howard County? Please be specific.*
Application Signature*
PLEASE READ: By submitting this application you hereby indicate that all of the provided information is your own original content and accurate to the best of your knowledge. You understand that a $125 application fee is due with your submission and your application will not be considered complete until this payment is received. Terms & Conditions. Once you submit this form you will be directed to a checkout page where you can complete the $125 application fee payment. Please type your name in full in the field below to indicate your acceptance and agreement . Thank you.
Application Submission Date*
Please input today's date to confirm your application submission.
Post Title

Leadership Premier 2027 Application

Personal Information

Employer Information

Work History

Education

Community Involvement

References

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